Occlusion in Dental Implants: Biomechanical Principles, Occlusal Concepts, and Clinical Considerations: A Review

Abstract

Dental implants differ fundamentally from natural teeth in their biomechanical behavior due to the absence of periodontal ligament, making occlusal considerations critical for long-term implant success. The purpose of this review was to evaluate implant occlusion concepts, biomechanical principles, occlusal schemes, and clinical guidelines for achieving optimal implant-supported prosthesis longevity. A narrative review of the literature was conducted using PubMed and prosthodontic textbooks. Articles focusing on implant biomechanics, occlusal loading, occlusal schemes, and implant complications related to occlusion were included. Implant occlusion requires modification of conventional occlusal principles. Axial loading, reduced occlusal contacts, shallow cusp inclines, and controlled occlusal schemes are recommended to minimize biomechanical overload. Appropriate occlusal design is essential to maintain peri-implant health and prosthesis longevity. Occlusal concepts must be individualized based on implant location, prosthesis type, and patient-specific risk factors. Understanding implant occlusion principles helps clinicians reduce mechanical and biological complications associated with occlusal overload.

Keywords

Introduction

Dental implant therapy has become a predictable treatment modality for the replacement of missing teeth. Despite high survival rates, implant-supported prostheses are susceptible to biological and mechanical complications, many of which are influenced by occlusal loading.

Unlike natural teeth, implants lack a periodontal ligament (PDL), resulting in reduced shock absorption and altered proprioception. Consequently, occlusal forces are transmitted directly to the bone–implant interface. Improper occlusal design can lead to complications such as screw loosening, prosthesis fracture, marginal bone loss, and implant failure. Therefore, occlusion plays a critical role in implant prosthodontics.

Biomechanical Differences Between Natural Teeth and Implants

The absence of the PDL results in:

• Reduced tactile sensitivity
• Increased stress concentration at the crestal bone
• Limited capacity to compensate for occlusal discrepancies

Occlusal Load and Implant Bone Response

Bone responds to mechanical loading according to Wolff’s law. Physiologic loading promotes bone maintenance, whereas excessive or non-axial forces can cause microdamage and marginal bone loss.

Occlusal overload may result in:

• Mechanical complications (screw loosening, framework fracture)
• Biological complications (bone loss, peri-implantitis)

Principles of Implant Occlusion

The concept of implant-protected occlusion, proposed by Misch, emphasizes minimizing occlusal stress on implants through prosthetic design modifications.

Key Principles

• Axial loading over implant long axis
• Narrow occlusal table
• Reduced cusp height
• Shallow occlusal anatomy
• Controlled occlusal contacts

Occlusal Contacts in Implant Prostheses

Centric Occlusion

• Light contact compared to adjacent natural teeth
• Simultaneous contact only in heavy clenching
• No premature contacts

Eccentric Occlusion

• No contact on implant restorations in lateral or protrusive movements whenever possible
• If unavoidable, contacts should be light and shared

Occlusal Schemes in Implant Dentistry

1. Mutually Protected Occlusion

• Preferred in partially edentulous patients
• Natural teeth guide eccentric movements
• Implant restorations receive minimal lateral forces

2. Group Function

• Acceptable when canine guidance is not feasible
• Implant involvement should be minimized

3. Balanced Occlusion

• Indicated in implant-supported complete dentures
• Enhances prosthesis stability

Implant Occlusion in Different Prosthetic Situations

Single Implant Crown

• Light centric contact
• No excursive contacts
• Narrow occlusal table

Implant-Supported Fixed Dental Prosthesis

• Even distribution of occlusal contacts
• Avoid cantilevers
• Use splinting when indicated

Implant-Supported Overdentures

• Balanced occlusion preferred
• Reduced cusp height to minimize tipping forces

Influence of Parafunction

Bruxism and clenching significantly increase occlusal load. In such patients:

• Increase implant number and diameter
• Use metal occlusal surfaces where indicated
• Provide occlusal splints

Occlusal Materials and Force Transmission

Material selection influences force absorption:

• Metal occlusal surfaces transmit less stress
• Ceramics offer esthetics but require controlled occlusion
• Monolithic zirconia requires precise occlusal adjustment

DISCUSSION

Although implants demonstrate high survival rates, occlusal overload remains a significant risk factor for complications. Evidence suggests that mechanical failures are more closely related to occlusal discrepancies than biological failures. Clinicians must adopt a prosthetically driven, patient-specific approach to implant occlusion.

CONCLUSION

Implant occlusion differs fundamentally from natural tooth occlusion. Proper occlusal design—emphasizing axial loading, reduced occlusal contacts, and controlled occlusal schemes—is essential for long-term success of implant-supported prostheses.

REFERENCES

1. Misch CE. Occlusal considerations for implant-supported prostheses. Dent Clin North Am. 1995;39:395–413.
2. Misch CE. Dental Implant Prosthetics. 2nd ed. Mosby; 2015.
3. Rangert B, Jemt T, Jörnéus L. Forces and moments on Branemark implants. Int J Oral Maxillofac Implants. 1989;4:241–247.
4. Duyck J, Naert I. Failure of oral implants: aetiology, symptoms and influencing factors. Clin Oral Investig. 1998;2:102–114.
5. Kim Y, Oh TJ, Misch CE, Wang HL. Occlusal considerations in implant therapy. Periodontol 2000. 2005;39:139–155.
6. Geng JP, Tan KB, Liu GR. Application of finite element analysis in implant dentistry. J Prosthet Dent. 2001;85:585–598.
7. Gross M. Occlusion in implant dentistry. Aust Dent J. 2008;53:S65–S69.
8. Mericske-Stern R. Forces on implants supporting overdentures. Int J Oral Maxillofac Implants. 2006;21:594–603.
9. Brunski JB. Biomechanical factors affecting the bone–dental implant interface. Clin Mater. 1992;10:153–201.
10. Schierz O, et al. Influence of occlusal forces on peri-implant bone. J Oral Rehabil. 2014;41:541–548.